- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,344.23 / $16,595.87 / $38,904.51
| Facility | | $2,344.23 | $16,595.87 | $38,904.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $5,011.87 / $9,332.54
| Professional | | $323.59 | $5,011.87 | $9,332.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,122.02 / $1,122.02 / $14,791.08
| Professional | | $1,122.02 | $1,122.02 | $14,791.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $4,897.79 / $30,199.52
| Facility | | $478.63 | $4,897.79 | $30,199.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $691.83 / $2,570.40 / $24,547.09
| Professional | | $691.83 | $2,570.40 | $24,547.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,230.27 / $2,041.74 / $21,877.62
| Professional | | $1,230.27 | $2,041.74 | $21,877.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $478.63 / $2,570.40 / $29,512.09
| Facility | | $478.63 | $2,570.40 | $29,512.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.26 / $436.52 / $14,791.08
| Professional | | $60.26 | $436.52 | $14,791.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $8,317.64 / $17,782.79
| Professional | | $891.25 | $8,317.64 | $17,782.79 |